Abstract
Corneal endothelial transplantation or endothelial keratoplasty has become the preferred choice of transplantation for patients with corneal blindness due to endothelial dysfunction. Currently, there is a worldwide shortage of transplantable tissue, and demand is expected to increase further with aging populations. Tissue-engineered alternatives are being developed, and are likely to be available soon. However, the cost of these constructs may impair their widespread use. A cost-minimization analysis comparing tissue-engineered constructs to donor tissue procured from eye banks for endothelial keratoplasty was performed. Both initial investment costs and recurring costs were considered in the analysis to arrive at a final tissue cost per transplant. The clinical outcomes of endothelial keratoplasty with tissue-engineered constructs and with donor tissue procured from eye banks were assumed to be equivalent. One-way and probabilistic sensitivity analyses were performed to simulate various possible scenarios, and to determine the robustness of the results. A tissue engineering strategy was cheaper in both investment cost and recurring cost. Tissue-engineered constructs for endothelial keratoplasty could be produced at a cost of US$880 per transplant. In contrast, utilizing donor tissue procured from eye banks for endothelial keratoplasty required US$3,710 per transplant. Sensitivity analyses performed further support the results of this cost-minimization analysis across a wide range of possible scenarios. The use of tissue-engineered constructs for endothelial keratoplasty could potentially increase the supply of transplantable tissue and bring the costs of corneal endothelial transplantation down, making this intervention accessible to a larger group of patients. Tissue-engineering strategies for corneal epithelial constructs or other tissue types, such as pancreatic islet cells, should also be subject to similar pharmacoeconomic analyses.
Highlights
The cornea is a five-layered structure in the anterior segment of the eye
Full-thickness penetrating keratoplasty (PK) techniques have been replaced by newer partial-thickness techniques for many corneal diseases [2,3,4,5,6]
A cost-minimization analysis comparing the use of tissueengineered constructs versus procured tissue for endothelial keratoplasty (EK) was performed, based on the following assumptions: 1. EK procedures performed with either tissue-engineered constructs or precut procured tissue are identical in surgical technique, visual outcomes, complications and utility
Summary
The cornea is a five-layered structure in the anterior segment of the eye. The corneal endothelium pumps fluid out of the cornea, maintaining corneal deturgescence, which is crucial for corneal transparency and clear vision. Corneal endothelial dysfunction may be inherited e.g. Fuchs’ endothelial dystrophy, or acquired due to surgical trauma e.g. pseudophakic bullous keratopathy. These are the leading causes of corneal transplantation in most developed countries [1]. The field of corneal transplantation has evolved rapidly in the past 10 years. Full-thickness penetrating keratoplasty (PK) techniques have been replaced by newer partial-thickness techniques for many corneal diseases [2,3,4,5,6]. DSEK involves transplanting a posterior lamellar corneal graft, consisting of donor corneal endothelium, Descemet’s membrane, and a layer of posterior stroma, to replace dysfunctional recipient corneal endothelium. DSEK grafts can be precut prior to surgery, which simplifies the procedure and reduces operating time [12,13]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
